Acetaminophen

What Is Acetaminophen (Tylenol)?

Acetaminophen is the generic name for Tylenol, a pain reliever and fever reducer. It's one of the most widely used pain medications in the world.

Sold mainly over-the-counter (OTC) to treat a variety of conditions — headaches, muscle aches, toothaches, arthritis — acetaminophen is the active ingredient not only in Tylenol but also in Panadol, Feverall, and many other drugs.

It's also included in Theraflu, Nyquil, Sudafed, and other medications used to treat coughs, colds, and flu.

As a prescription drug, acetaminophen is usually combined with narcotic pain medicines, such as codeine (Tylenol with Codeine #3 or Tylenol with Codeine #4) or hydrocodone (Norco), to treat more severe pain.

Acetaminophen, also called APAP, belongs to a class of painkillers called non-opioid analgesics. They work by blocking the enzyme that produces pain- and inflammation-generating prostaglandins.

Acetaminophen Overdose

While considered safe and effective when taken as directed, acetaminophen is not without serious risks.

Taking more than the maximum dosage of 3,000 to 4,000 milligrams a day — even just small amounts more — can cause serious liver damage, even death, according to the FDA.

Often these overdoses are inadvertent and occur when people unknowingly take more than one acetaminophen-containing medication at the same time.

If you think you've overdosed on acetaminophen, seek medical treatment immediately, even if you don't have symptoms, as symptoms can take many days to appear.

Other Acetaminophen Warnings

McNeil, the maker of Tylenol, has faced more than 80 federal personal injury lawsuits over the drug's safety.

Since 2011, after decades of regulatory tussle, the FDA has required that a black box warning be added to the label of all prescription (not OTC) acetaminophen medications, highlighting that that the drug carries a potential for acute liver failure.

The FDA also moved to limit the amount of acetaminophen in prescription drugs to 325 mg per dose, and added a warning to prescription labels about the potential for allergic reactions.

Before taking any medication containing acetaminophen, you need to tell your doctor if you've ever had liver disease, or a history of alcoholism.

Your doctor also needs to know about any allergies you have, and about any other drugs you are taking — prescription or OTC — as they might also contain acetaminophen, or interact with it.

Tylenol and Pregnancy

Acetaminophen might cause harm to a developing fetus.

Acetaminophen is excreted in small quantities in breast milk and is therefore not recommended while breastfeeding.

In an advisory issued in January 2015, the FDA announced that it had reviewed recent studies evaluating the safety of prescription and OTC pain medicines containing acetaminophen when used during pregnancy and ruled that they are "too limited to make any recommendations... at this time."

However, the agency also noted that the use of all pain medicines during pregnancy should be carefully considered and urged pregnant women to always discuss all medicines with their health care professionals before using them.

A 2016 study in the journal JAMA Pediatrics found that prenatal exposure to acetaminophen was linked with an increased risk of behavioral problems in children, especially when taken during the third trimester of pregnancy.

Tylenol and Alcohol

If you consume three or more alcoholic drinks a day, discuss with your doctor whether you should take acetaminophen.

People with known alcoholic liver disease are more susceptible to Tylenol-induced liver injury.

A study presented in 2013 at the annual meeting of the American Public Health Association found that combining acetaminophen-based pain relievers such as Tylenol and even small amounts of alcohol can more than double your risk of kidney disease.

Medications that combine acetaminophen and codeine or hydrocodone should not be consumed with alcohol.

Acetaminophen FAQ

Q: Is it okay to take Benadryl Allergy while taking Tylenol Arthritis?

A: Benadyl Allergy can be taken with the Tylenol Arthritis. Be careful because the Benadyl can cause drowsiness. Avoid alcohol while taking the Benadryl as it will increase drowsiness. If you take Benadryl at bedtime or before a nap, be sure to sit up for a few minutes before trying to get up in case you have dizziness from the Benadryl.

Q: I have a 15-year-old son who weighs 171 pounds. He has a high fever of 102.4, and his doctor said he had a virus infection but gave him no antibiotics. Can I give him two Tylenol 500 mg? My 9-year-old daughter who weighs 53 lbs has the same illness and didn't get antibiotics either. I'm giving her Motrin, two tablets every four hours.

A: Tylenol can be given to both children for fever. The 15-year-old should probably stick to taking one extra-strength tablet every 6 hours. The 9-year-old can take 325 mg of Tylenol safely, one regular-strength tablet or 2 teaspoons of children's Tylenol Elixir.

Q: Can I take Ambien with Tylenol?

A: According to the package insert for Ambien, Tylenol is not listed as a drug interaction. It's important to consult with your physician or healthcare provider about any specific questions regarding your medical conditions or medications, particularly before taking any action.

Q: I have chronic lower back pain, and I need to take a pain killer. But I hesitate to do so. My reason is that I take the following drugs daily, and I am worried that Tylenol will complicate their effectiveness. My daily medications are: omeprazole 20 mg, Zocor 40 mg, niacin 1000 mg, Centrum Silver-Ultra Men's, Hyzaar 50-12.5, metoprolol succinate 25mg, finasteride 5 mg, tamsulosin 0.4 mg, aspirin 81 mg, and docusate calcium 240 mg

A: You should be able to add Tylenol to your medications for pain relief. You should consult with your health care provider on how much Tylenol (acetaminophen) they would want you to take. For more information you can go to //www.everydayhealth.com/drugs/tylenol Gerald Levy, RPh

Q: What are the long term negative effects of taking Arthritis Extra Strength Tylenol?

A: Honestly, it depends on a lot of other things. There have been people in geriatric home care who have taken high dose Tylenol (acetaminophen) for years and years with no problems. However, other medications, disease states and extreme dietary modifications can influence how your body metabolizes Tylenol. I usually tell most people to have liver enzymes checked every 6 months and to watch their body for unusual aches and pains (with or without fever) that go away when the Tylenol is discontinued. Please visit us here for more information: //www.everydayhealth.com/drugs/tylenol Matt Curley, PharmD

Q: At times, my 82 year old father-in-law takes Xanax at night. He also would like to take Aleve or Tylenol for the pain. Is this harmful? He has heart conditions.

A: Taking Xanax (alprazolam) along with over the counter pain relievers is not a problem. Choosing the correct pain reliever with his heart conditions is the most important issue. All nonsteroidal anti-inflammatory drugs (NSAIDs), including Aleve (naproxen) and Motrin (ibuprofen), have been reported to cause cardiovascular events, such as a heart attack or stroke, which can result in loss of life. People who have heart disease or cardiovascular risk factors appear to be at greater risk. To decrease the chances of these problems occurring, people should take the smallest effective dosage for the shortest period of time. Tylenol (acetaminophen) is a popular over-the-counter pain medication that is an alternative to NSAIDs and aspirin. Tylenol is a safer choice for pain relief for patients with heart or blood pressure conditions. Lori Poulin, PharmD

Q: I can never locate Tylenol at the store. Why is it so difficult to find?

A: Tylenol (acetaminophen) is usually in the pain relief or analgesic section of the over-the-counter medications at your local pharmacy. The pharmacy staff should be able to help you find it. Tylenol comes in several different strengths, so be sure you get the correct one; as your pharmacist if you're not sure which you need. Acetaminophen is the generic of Tylenol and contains the same active ingredient, so it's a good substitute for brand name Tylenol. Some generic or store brands of acetaminophen say "pain reliever" or "aspirin-free pain reliever" on the label. You can check the back of the bottle to be sure acetaminophen is the drug in the product, or ask your pharmacist for help.For more information on Tylenol (acetaminophen), go to //www.everydayhealth.com/drugs/tylenol. Laura Cable, PharmD

Q: Yesterday at I took two tylenol pills because I was in pain, and three hours later I had three alcoholic drinks. Is this dangerous?

A: Generally, avoid alcohol during treatment with Tylenol (acetaminophen). Together, alcohol and acetaminophen can damage the liver. This usually happens with chronic drinking (patients who drink three or more drinks every day) and acetaminophen therapy. If you drink three or more drinks per day, talk to your health care provider before using acetaminophen. You may also find helpful information at //www.everydayhealth.com/drugs/tylenol Sarah Lewis, PharmD

Q: When I get the flu, can I use Tylenol?

A: Tylenol (acetaminophen) or Motrin (ibuprofen) can both be used for fever. Dosages are different for children than for adults. Do not use aspirin under any circumstance if you have a fever. However, products made by Johnson & Johnson (Tylenol and Children's Motrin Liquid) have been recalled and temporarily taken off the market. If the fever continues for more than two days or goes over 101 degrees F, contact your doctor at once. Gerald Levy, RPh

Q: Why the sudden Tylenol recall ? Should I dump my present stock?

A: On May 1, 2010, McNeil Consumer Healthcare voluntary recalled infant and children's liquid products due to manufacturing deficiencies that may affect quality, purity, or potency. The products include certain liquid infant's and children's Tylenol, Motrin, Zyrtec, and Benadryl products. While the potential for serious adverse events is remote, the Food and Drug Administraion advises consumers who have purchased these recalled products to discontinue use. The following link provides specific information on the products involved and what to do if you have any of them. For more information, please consult with your health care provider. Michelle McDermott, PharmD

Q: If you take heart medication and blood thinners, is it safe to take Tylenol?

A: Tylenol (acetaminophen) may interact with other medications, including some heart medicines and blood thinners. In order to completely answer your question about drug interactions, we need the names of each medication you are currently taking. If you would like to try again or submit a new question, please return to the Ask a Pharmacist page at www.everydayhealth.com/drugs. Michelle McDermott, PharmD

Q: What are the side effects from taking Tylenol PM?

A: Tylenol PM is a mixture of acetaminophen and diphenhydramine. It is marketed as a combined analgesic and sedative. Common side effects with diphenhydramine, one of the active ingredients in Tylenol PM, include motor impairment, dry mouth and throat, flushed skin, rapid or irregular heartbeat, blurred vision at nearpoint owing to lack of accommodation, abnormal sensitivity to bright light, pupil dilation, urinary retention, constipation, difficulty concentrating, short-term memory loss, visual disturbances, hallucinations, irregular breathing, dizziness, irritability, itchy skin, confusion, decreased body temperature (generally in the hands and/or feet), erectile dysfunction, excitability, and delirium. These are not all the side effects of Tylenol PM. For a complete list, talk to your healthcare provider. Use of TYLENOL

Q: Can Tylenol be used before a colonoscopy?

A: While aspirin and anti-inflammatory medications should not be used, as they can cause unwanted bleeding, Tylenol (the generic name is acetaminophen) can be used. Tylenol (acetaminophen) does not cause the unwanted bleeding. Patti Brown, PharmD

Q: Is it good to take Tylenol PM every night?

A: Tylenol PM contains acetaminophen and diphenhydramine, an antihistamine. It is used to help reduce aches and pain and to help a person rest. Over-the-counter medicines for pain, fever, or sleeplessness are intended only for temporary relief. If your problems continue beyond 10 to 14 days, you should stop using the product and speak with your health care provider. It is important to follow dosing instructions on the label and check all other medications for acetaminophen or diphenhydramine. Acetaminophen can cause liver problems if too much is taken or if it is taken with alcohol. For more information on sleeplessness, please visit //www.everydayhealth.com/insomnia/guide/. Michelle McDermott, PharmD

Q: Can arthritis-strength Tylenol and 81 mg aspirin be taken together? If not, how many hours apart?

A: Tylenol (acetaminophen) and aspirin may be taken together as there are currently no known drug interactions. There may be a slightly increased chance of stomach upset and/or abdominal pain. Always follow the labeling on any over-the-counter (OTC) medication since they are proven to be safe and effective for use without physician consent when used according to the product labeling. It is always a good idea to double check with a doctor or pharmacist before starting any new medications to determine if the new medication is right for you based on your personal health and to make sure that no interactions will take place. Megan Uehara, PharmD

Q: What's going on with Tylenol? It's been taken off the shelves twice this year, and not much is being said on the news. However, I read that there have been deaths attributed to this. Why is nothing being reported? My pharmacist told me he can't give out any information. What's going on? There is still no Tylenol on the shelves.

A: According to the press release by Ortho McNeil (the maker of Tylenol), the recalls were voluntary because the products did not meet the required quality standards. The recall was not undertaken on the basis of adverse medical events. Adult products included Tylenol and Motrin products including Tylenol PM.

Q: Can I have a couple of cocktails when I'm using Tylenol PM?

A: Tylenol PM contains acetaminophen and diphenhydramine, a pain medication and an antihistamine. Alcohol should be avoided while taking diphenhydramine since they both can cause depression of the central nervous system (causing drowsiness, etc.). Those who drink 3 or more alcoholic beverages a day should avoid taking Tylenol (acetaminophen) due to the risk of liver damage. Your health care provider may be able to provide more information. You can also find helpful information on Tylenol PM at //www.everydayhealth.com/drugs/tylenol-pm Laura Cable, PharmD, BCPS

Q: Since Tylenol for children has been recalled, what do you suggest we use? Is Advil for fever okay?

A: It is great that you are aware of the Tylenol (acetaminophen) recall and that you are looking for alternative medications. Only the brand name Tylenol liquid formulations have been recalled. Using a generic or store brand product containing acetaminophen is one option. Also, Advil is fine since it has not been recalled. The recall includes brand names Tylenol, Motrin, Benadryl, and Zyrtec. Megan Uehara, PharmD

Q: What are the effects of taking Tylenol #3 and over-the-counter drugs, such as zinc, vitamin C, Caltrate, Metamucil, and fish oil?

A: There are no known drug interactions found between Tylenol with codeine and the following over-the-counter medications: Vitamin C, Caltrate, fish oil, zinc, and Metamucil. Talk to your doctor if you have any concerns about your prescription or over-the-counter medications. Do not start or stop any medications or treatments without first talking to your doctor. I believe you will find the following links at everydayhealth.com also very helpful for your current situation: //www.everydayhealth.com/drugs/acetaminophen-codeine. Jennifer C. PharmD

Q: Is it safe to take Extra-Strength Tyenol at 77?

A: Tylenol Extra Strength (acetaminophen) is a medication to help pain. Tylenol Extra Strength (acetaminophen) is considered safe at 4000 mg (4 grams) per day or less. However, it can be hard on the liver, and may need a decrease in dose if you drink alcohol or have a liver problem. Tylenol (acetaminophen) is also found in many prescription pain relievers. The label will usually say "APAP" in the name. If you take a prescription medication containing Tylenol (acetaminophen), make sure to figure that dosage into your total daily dosing to make sure you stay below 4000mg in a day, or less. There was a recall on some of the Tylenol (acetaminophen) products, because a "moldy" smell was found. The stores quickly pulled them, and what you see on the shelf now will not be a recalled product. If you have Tylenol Extra Strength (acetaminophen) that was bought prior to the recall, you can check to see if what you bought is on the recall list.

Q: Is infant Tylenol safe to buy after the recall?

A: Most of the reputable stores have pulled all of the affected medications off the shelves. If there is product currently on the shelves, it is likely that it has been cleared by McNeil and Johnson & Johnson for use. Typically, I tell most patients to give it some time for full recovery from the process and use an alternative generic brand in the meantime. M. Curley, PharmD

Q: What sypmtoms do you get after quitting Tylenol PM?

A: Your question concerns Tylenol-PM (acetaminophen-diphenhydramine) (//www.everydayhealth.com/drugs/tylenol-pm). None of the ingredients in Tylenol PM is at all addictive, so there should be no symptoms associated with quitting. If you were taking Tylenol PM for an extended period of time and are now having any unpleasant feelings, it is always a good idea to check with one

Q: How safe is taking 3000 mg of Tylenol for an extended period for recuperation from surgery?

A: Tylenol (acetaminophen) is a medication used for the treatment of mild to moderate pain and fever. The maximum daily dose of Tylenol (acetaminophen) is 4 grams or 4,000 mg. It is important to include all sources of Tylenol (acetaminophen) in calculating the total daily dose as acetaminophen is found in many over the counter medications including cold medications. Those with liver or kidney disease may need lower doses. Patients who drink three or more alcoholic beverages a day should avoid Tylenol (acetaminophen) due to the risk of liver damage. Other than the above cautions it is considered safe to take 4,000 mg or less of acetaminophen a day. Laura Cable, PharmD

Q: What pain medicine can I take for headaches while I'm pregnant?

A: Tylenol (acetaminophen) is believed to be safe in pregnancy when used intermittently for short durations. Acetaminophen has not been formally assigned to a pregnancy category by the FDA. However, it is routinely used for short term pain relief and fever in all stages of pregnancy. Acetaminophen should only be given during pregnancy when need has been clearly established. NSAIDS, like ibuprofen (Motrin and Advil) and naproxen (Aleve) should not be used during pregnancy unless directed by your doctor. Consult your health care provider for specific recommendations. Always read and follow the complete directions and warnings on over-the-counter medications and discuss their use with your doctor before taking them. You may also find helpful information at //www.everydayhealth.com/drugs/tylenol Sarah Lewis, PharmD

Q: I take 2 Tylenol 500 mg/day. Should I stop taking the drug?

A: Your question raises two possible issues. First, there was a recent recall of Tylenol products. According to a McNeil Consumer health care Press Release from July 8, 2010, 21 lots of over-the-counter medicines have been recalled, including Benadryl, Motrin IB, Tylenol, and Tylenol PM. This recall is in addition to a product recall that McNeil Consumer health care originally announced on January 15, 2010, which included liquid products that contained trace amounts of a chemical called 2,4,6-tribromoanisole (TBA). The risk of serious adverse medical events is remote. This recall is being conducted with the knowledge of the U.S. Food and Drug Administration (FDA). The additional recall is a precautionary measure after a continuing internal review determined that some packaging materials used in the lots had been shipped and stored on the same type of wooden pallet that was tied to the presence of TBA in earlier recall. Consumers who purchased product from the lots included in this recall should stop using the product and contact McNeil Consumer health care for instructions on a refund or replacement. For these instructions, and information regarding how to return or dispose of the product, consumers should log on to the internet at www.mcneilproductrecall.com or call 1-888-222-6036 (Monday-Friday 8 a.m. to 8 p.m. Eastern Time, and Saturday-Sunday 9 a.m. to 5 p.m. Eastern Time). Consumers who have medical concerns or questions should contact their health care provider. Any adverse reactions may also be reported to the FDA

Q: What is the Tylenol recall about? Which ones and why?

A: McNeil Consumer health care announced a voluntary recall on many of their over-the-counter Tylenol, Motrin, Benadryl, and Zyrtec products. Consumers were complaining of a musty or moldy smell which has been linked to a chemical found in the shipping materials where product was shipped and stored on. Consumers are advised not take any medications from the recalled lots and contact McNeil Consumer health care for instruction on refund or replacement. For more information on the recall and complete list of lot numbers, visit McNeil

Q: Will Tylenol harm your body if taken every day?

A: The maximum recommended dose for Tylenol (acetaminophen) for pain and/or fever, is 4000mg (4 grams) per day. Doses higher than this can lead to liver damage, as the medication leaves the body through a pathway in the liver. Alcohol also leaves the body through the liver, and if it is combined with Tylenol (acetaminophen) over a long period of time, liver damage may occur. Some prescription medications, for pain, also contain Tylenol (acetaminophen), so if you take pain medicine with the abbreviation "APAP" in the name, make sure your total amount of daily Tylenol (acetaminophen) does not exceed 4000mg (4grams). A recent study on 1,700 women, over 11 years, also showed a possible reduction in kidney function (10% of people taking Tylenol (acetaminophen)). The percent increased in women who took 1,500 to 9,000 tablets in their "lifetime," by 64%, however, this is a large range to measure such an increase. It may need to be broken down further to see if most of the 64% were in the higher range or not. You should consult your doctor to see if you are able to alternate Tylenol (acetaminophen) with an NSAID (non-steroidal anti-inflammatory drug), such as Motrin/Advil (ibuprofen) or Aleve (naproxen). They work differently than Tylenol (acetaminophen) and have the additional function of decreasing inflammation. However, people with a history of ulcers or GI (gastrointestinal) bleeding should not take NSAIDs, as they block the prostaglandins that make your blood clot, and can cause a GI bleed. If you can limit all of the pain relievers to just when they are needed, instead of everyday, they may be "safer" than taking them everyday. You can also ask your doctor for liver and kidney function tests. Sometimes, the benefits, versus risks must be weighed to make a decision, and you should talk to your doctor about this. Patti Brown, PharmD

Q: What is Tylenol?

A: Tylenol (acetaminophen) is an analgesic used to treat mild to moderate pain and fever. The maximum daily dose of Tylenol (acetaminophen) is 4000mg (4grams) daily. It is important to note that some prescription pain medications or cough and cold medications also contain acetaminophen. It is important to not have more than 4 grams of acetaminophen a day from all sources. Tylenol (acetaminophen) can affect the liver so patients who already have liver damage should avoid taking Tylenol (acetaminophen). Patients who drink more than 3 alcoholic drinks a day should avoid taking Tylenol (acetaminophen) due to the increased risk of liver damage. Laura Cable, PharmD

Q: Why was Tylenol recalled?

A: According to a McNeil Consumer health care Press Release from July 8, 2010, 21 lots of over-the-counter medicines have been recalled, including Benadryl, Motrin IB, Tylenol, and Tylenol PM. This recall is in addition to a product recall that McNeil Consumer health care originally announced on January 15, 2010, which included liquid products that contained trace amounts of a chemical called 2,4,6-tribromoanisole (TBA). The risk of serious adverse medical events is remote. This recall is being conducted with the knowledge of the US Food and Drug Administration (FDA). The additional recall is a precautionary measure after a continuing internal review determined that some packaging materials used in the lots had been shipped and stored on the same type of wooden pallet that was tied to the presence of TBA in earlier recall. Consumers who purchased product from the lots included in this recall should stop using the product and contact McNeil Consumer health care for instructions on a refund or replacement. For these instructions, and information regarding how to return or dispose of the product, consumers should log on to the internet at www.mcneilproductrecall.com or call 1-888-222-6036 (Monday-Friday 8 a.m. to 8 p.m. Eastern Time, and Saturday-Sunday 9 a.m. to 5 p.m. Eastern Time). Consumers who have medical concerns or questions should contact their health care provider. Any adverse reactions may also be reported to the FDA

Q: Which Tylenol has been recalled? Capsules, caplets, tablets ...?

A: On June 15, 2010, McNeil Pharmaceuticals expanded their product recall to include one lot of Tylenol Extra Strength Rapid Release Gels. The recall involves one lot number of this product. The recall only involves brand name Tylenol and not generic products made by other companies. McNeil is working with the U.S. Food and Drug Administration (FDA) and keeping them informed about the recall status. Information for the public is available at the company's website: www.mcneilproductrecall.com or by calling the phone number listed on the website (888)222-6036. The website contains specific information on which products and lot numbers are affected. It gives access to customer support and information about refunds and product coupons. For specific questions or concerns about the recall, please contact McNeil directly for the most accurate information. Tylenol (acetaminophen) is a pain reliever and a fever reducer. It is used to treat many conditions such as headache, muscle aches, arthritis, backache, toothaches, colds, and fevers. Brand name Tylenol is available in a variety of dosage forms and strengths. And acetaminophen is widely available in generic form. So, there are a many choices available for continued use of acetaminophen during McNeil's recall. Your local pharmacist is a good resource to help you choose a product that is right for you. Always read and follow the complete directions and warnings on over-the-counter products and discuss their use with your health care provider before taking them. Never take more Tylenol than directed on the label. Too much Tylenol can be dangerous and damaging to your liver. If you do not understand the directions on the product label, consult your doctor or local pharmacist for help. Sarah Lewis, PharmD

Q: When will the Tylenol recall end?

A: The reason for the recall is because consumer complaints of a musty or moldy odor, which has been linked to the presence of trace amounts of a chemical called 2,4,6-tribromoanisole (TBA) has been found in some containers of Tylenol products with certain lot numbers. The risk of serious adverse medical events is remote. Not all Tylenol (acetaminophen) products are affected, only certain Tylenol products with certain lot dates. The only affected Tylenol products are Children

A: The reason for the recall is because consumer complaints of a musty or moldy odor, which has been linked to the presence of trace amounts of a chemical called 2,4,6-tribromoanisole (TBA) has been found in some containers of Tylenol products with certain lot numbers. The risk of serious adverse medical events is remote. Not all Tylenol (acetaminophen) products are affected, only certain Tylenol products with certain lot dates. The only affected Tylenol products are Children

Q: Has there been a new recall on Tylenol products?

A: Yes, as of July 9, 2010, another Tylenol recall was announced including adult and children's medications. For all products that are included in the recall, you should visit the manufacturer website where you can find all the information you need. This website also offers a place where you can input your product information that you have at home to see if it is one of the lots affected. Click on this link for more information: http://www.mcneilproductrecall.com/ Lori Mendoza, PharmD Poulin, PharmD

Q: Is it safe to take tylenol during pregnancy a few times a week for body aches?

A: Tylenol (acetaminophen) is usually safe during pregnancy. However, do not take above the recommended amount which is 4000 mg/day. Excessive acetaminophen can cause liver failure. Also stay away from ibuprofen and aspirin-like anti-inflammatory drugs (NSAIDs) because these drugs can reduce amniotic fluid and thin the blood. This could make it harder to stop a hemorrhage or bleeding during labor. For more information on Tylenol visit Everyday Health at the link //www.everydayhealth.com/drugs/ Kimberly Hotz, PharmD.

Q: What is an alternative to Children's Tylenol?

A: The recall only affected the brand name product so any generic/store version is fine. The generic name for Tylenol is acetaminophen so just check for that ingredient in the generic versions. If you are trying to avoid Tylenol completely, children's Motrin (generic name ibuprofen) would be the alternative medication. Megan Uehara, PharmD

Q: Is there a recall on tylenol rapid release?

A: According to McNeil Consumer Healthcare, the manufacturer of Tylenol, five lots of medication have been recalled in addition to the primary recall of products back in January 2010. Included in the additional recall is one product lot of Tylenol Extra Strength Rapid Release Gelcaps, 50 count, that were sold in the United States, Trinidad and Tobago, Bermuda and Puerto Rico. The product recall information is NDC Code # 50580-488-50; UPC # 300450488503; LOT # ASA202. If your bottle of Tylenol Extra Strength Rapid Release Gelcaps is part of the recalled lot, you can request a refund or product coupon from the manufacturer. For more specific information, consult with your doctor or pharmacist for guidance based on your health status and current medications, particularly before taking any action. Beth Isaac, PharmD

Q: Why was Tylenol suddenly recalled? Should I dump out what I still have in my cupboard?

A: On May 1, 2010, McNeil Consumer Healthcare, the manufacturer, voluntarily recalled infant and children's liquid products due to manufacturing deficiencies that may have affected quality, purity, or potency. This included certain liquid infant's and children's Tylenol, Motrin, Zyrtec, and Benadryl products. While the potential for serious problems is remote, the Food and Drug Administration advises consumers who have purchased these recalled products to discontinue their use. You can also discuss any concerns you have about your products with your doctor. Michelle McDermott, PharmD

Q: Was Tylenol for Arthritis recently recalled?

A: In December of 2009, McNeil Consumer Healthcare, the makers of Tylenol, issued a recall of all lots of Tylenol Arthritis Pain in the 100-count bottles with easy-open caps. In January of 2010, the same company issued a broader recall that included more of its products that might have been affected. The recall followed an investigation of reports from consumers of bottles having moldy, musty or mildew-like odors. In some cases, there were also reports of temporary gastrointestinal effects such as nausea, stomach pain, vomiting and/or diarrhea. McNeil stated that it believed that the odor was caused by trace amounts of a chemical, known as TBA, which is somehow linked to the wood pallets used to transport and store packaging materials. For more specific information, consult with your doctor or pharmacist for guidance based on your health status and current medications, particularly before taking any action. Gregory Latham, RPh

Q: Is Tylenol 325mg safe to take or was it recalled also? Why did they quit making it?

A: Tylenol (acetaminophen), and is a medication used to to help relieve pain. Tylenol (acetaminophen) is considered safe at 4000mg (4grams) per day or less. However, it can be hard on the liver, and may need a decrease in dose if you drink alcohol or have a liver problem. Tylenol (acetaminophen) is also found in many prescription pain relievers. The label will usually say "APAP" in the name. If you take a prescription medication containing Tylenol (acetaminophen), make sure to figure that dosage into your total daily dosing to make sure you stay below 4000mg in a day, or less. There was a recall on some of the Tylenol (acetaminophen) and Tylenol (acetaminophen) products, because a "moldy" smell was found. The stores quickly pulled them, and what you see on the shelf now will not be a recalled product. If you have Tylenol (acetaminophen) that was bought prior to the recall, you can check to see if what you bought is on the recall list. They did not quit making the product, but it is possible that your store was in between getting a new shipment of Tylenol and having the recalled version pulled from the shelves. The generic versions are made by different manufacturers, so they do not have the same problem and may be a good alternative for you to try, while you are waiting for the brand to be available for sale again. A generic has to contain the exact same active ingredient at the same amount, and it has to prove to the FDA that is is just as safe and effective as the brand. For this information on what was recalled, please visit the manufacturer's list of recalled medications. Patti Brown, PharmD

Q: Is it safe to take Tylenol Sinus during pregnancy?

A: Tylenol Sinus contains two medications, acetaminophen which is used to treat pain and fever and phenylephrine which is a decongestant used to treat sinus and nasal congestion. Acetaminophen (Tylenol) pregnancy category B and is generally considered safe to use during pregnancy for short, intermittent periods of time. Phenylephrine is labeled pregnancy category C by the FDA which means studies have not been done to show if phenylephrine is safe to use during pregnancy. Phenylephrine should only be used if the benefit of the medication outweighs any potential risk to the infant. Decongestants have the risk of increasing blood pressure. Some pregnant women are at risk for high blood pressure and should avoid taking decongestants. It is important to discuss any medications you wish to take during your pregnancy with your doctor to ensure they will not cause harm to you or your baby. For more specific information, consult with your doctor or pharmacist for guidance based on your health status and current medications, particularly before taking any action. Laura Cable, PharmD., BCPS

Q: Is Tylenol safe? I have a whole bottle of Tylenol Extra Strength. Can I use it?

A: Tylenol Extra Strength (acetaminophen) is a pain reliever and fever reducer available over-the-counter. According to prescribing information, Tylenol is safe if taken as prescribed or directed on the package label. Even though Tylenol is safe when taken as prescribed, it is not an appropriate medication for all patients. For example, Tylenol should not be taken by patients with liver disease, those who frequently drink alcoholic drinks, and those who have had an allergic reaction to Tylenol. For more specific information, consult with your doctor or pharmacist for guidance based on your health status and current medications, particularly before taking any action. Leslie Ako-Mbo, PharmD

Q: I am addicted to Tylenol #3, even when I don't have pain I take it. What can I do to stop? The pain is real, but the problem is I take it to make me sleep, relax me and other reasons.

A: Tylenol #3 (codeine/acetaminophen) is a combination pain reliever for moderate to severe pain. //www.everydayhealth.com/drugs/tylenol-with-codeine-3. Also limit the amount of acetaminophen taken per day. An overdose of acetaminophen can damage your liver. Adults should not take more than 1 gram (1000 mg) of acetaminophen per dose or 4 grams (4000 mg) per day. If you drink more than three alcoholic beverages per day, you should never use more than 2 grams (2000 mg) of acetaminophen per day. Codeine can be habit-forming and never should be taken other than who it was prescribed for.

Q: Why was Tylenol recalled? When can we expect 8-hour for muscular pain Tylenol to be back on the market?

A: According to a press release from the makers of Tylenol, the recall was initiated following consumer complaints of a musty or moldy odor, which has been linked to the presence of trace amounts of a chemical called 2,4,6-tribromoanisole (TBA) that was used on the pallets that the medication packages were shipped on. The manufacturer determined that some packaging materials used in the lots had been shipped and stored on the same type of wooden pallet that was tied to the presence of TBA in earlier recalled lots. All lots involved in the recall were produced before the Jan. 15, 2010 recall, after which McNeil stopped accepting shipments of materials from its suppliers on that type of pallet. It has also been determined that the risk of serious adverse medical events is remote. For more information on this recall, they have set up a Web site designed to answer any questions you have as well as the ability to check any lot numbers you may have at home. It is not known when the name-brand products of Tylenol will return to the shelves at this point. However, you can continue to use the store-brand generics of these medications. Since they are manufactured by different companies, they are not affected by the recall. The store-brand medications are formulated with the exact same ingredients as the name-brand products and will work the same way. For more specific information, consult with your doctor or pharmacist for guidance based on your health status and current medications, particularly before taking any action. Lori Poulin, PharmD

Q: I was taking two Tylenol PM every night to help me sleep for about two years. Then there was this recall, and I could not find out why or if I've been hurting myself. Why was it recalled? What damage have I done to myself by taking these pills, and is Aleve PM any better?

A: Tylenol PM was recalled due to a moldy smell linked to trace amounts of a chemical. The risk of serious adverse effects is remote. The affected Tylenol would have been taken off any pharmacies shelves. After new Tylenol PM is available, it should once again appear on the shelves. For more specific information, consult with your doctor or pharmacist for guidance based on your health status and current medications, particularly before taking any action. Laura Cable, PharmD

Q: Is Tylenol safe for a 6 month old baby?

A: Tylenol (acetaminophen) is a medication that is used in infants, children and adults to relieve pain and fever. There are minimal side effect concerns in a healthy child as long as the dosing directions are appropriately followed. The prescribing information on Tylenol Infant Drops shows the following as the safest dosing of the medication: A child weighing between 6 and 11 pounds would get a dose of 0.4 ml (1/2 of the dropper) every 4 to 6 hours. Between 12 to 17 pounds the dose would be 0.8 ml (1 dropperful). Between 18 to 23 pounds the dose would be 1 and 1/2 droppersful. These doses are based on the Tylenol Infant Drops only. You should consult with your physician on dosing any other type of Tylenol medication. You should always consult with your pediatrician as to the safest choice of over the counter medications for your child. Every physician has their own preferences on ways to treat the common cold, fever, and pain for their patients. Lori Poulin, PharmD

Q: Which Tylenol is not harmful to the liver and kidneys?

A: Tylenol (acetaminophen) is a non-prescription pain reliever and fever reducer. Compared to other non-prescription pain relievers, Tylenol is less likely to cause ulcers and to interact with other medications. However, it may be more likely to cause liver damage, especially when taken at very high doses or in people who already have liver damage. If you have liver disease or kidney disease, it would be best to consult with your physician as to the best over-the-counter pain reliever for your condition. He or she is better able to assist you with finding a medication that will not affect any health conditions or medications that you may have. For more specific information, consult with your doctor or pharmacist for guidance based on your health status and current medications, particularly before taking any action. Lori Poulin, PharmD

Q: I take extra-strength Tylenol. Is it safe to take every night?

A: Tylenol (acetaminophen) is safe when used at appropriate dosing. Since Tylenol is cleared through the liver, you shouldn't take more than 4,000 milligrams of Tylenol per day. Extra-Strength Tylenol is 500 milligrams per tablet. Normally, one to two tablets of Extra-Strength Tylenol are taken at one time, and taking this amount every night should be safe. Your doctor probably also monitors your liver function whenever you get bloodwork done, so you could ask whether the Tylenol is affecting your liver. Megan Uehara, PharmD

Q: What Tylenol products have been pulled off the shelves?

A: Tylenol products that have been recalled include only the brand name. Generics are made by other companies and are safe to take. In September of 2009, infant's and children's Tylenol was pulled, but more recently, due to a moldy, musty smell, Tylenol (for adults) was also recalled. Patti Brown, PharmD

Q: Tylenol was recalled here, but I was wondering if the products are still available in Canada?

A: The Tylenol recall wasn't sold in Canada. To make absolutely sure that your product is all right, you can visit the manufacturer's Web site at http://www.mcneilproductrecall.com. Patti Brown, PharmD

Q: I have a headache, but I also would love to drink a beer right now. Is Tylenol going to interact with a Budweiser?

A: Tylenol (acetaminophen) can affect the liver so patients who already have liver damage should avoid taking Tylenol (acetaminophen). Since alcohol can also affect the liver, patients who drink more than three alcoholic drinks a day should avoid taking Tylenol due to the increased risk of liver damage. Your health care provider can provide you with more information. Please see the following Everyday Health link for more information on Tylenol (acetaminophen). //www.everydayhealth.com/drugs/tylenol. Laura Cable, PharmD

Q: Is Tylenol Arthritis safe to take?

A: Tylenol Arthritis is safe to take as long as it is being taken at recommended dosages. Typically, the maximum daily dosage of Tylenol (acetaminophen) is 4,000 mg. One Tylenol Arthritis tablet is 650 mg. The normal dosage for Tylenol Arthritis is one to two tablets every eight hours (not recommended to exceed six tablets in a 24-hour period). Tylenol is broken down by the liver, so if a person has liver problems, it is best to ask the physician before taking any Tylenol products. Megan Uehara, PharmD

Q: What are the dangers of taking Tylenol with acetaminophen in it?

A: Tylenol is the brand name for acetaminophen. Tylenol is in a drug class called analgesics (pain relievers) and antipyretics (fever reducers). Tylenol is used to treat mild to moderate pain associated with headache, muscle aches, menstrual periods, the common cold, sore throat, toothaches, backaches, and reactions to vaccines. Tylenol is also used to alleviate pain from osteoarthritis. Tylenol is also used to reduce fever. Tylenol works by altering the way in which the body feels pain and by cooling the body. Although Tylenol may be effective in treating mild to moderate pain, Tylenol does not reduce inflammation or swelling. Tylenol is relatively safe, if used as directed by the doctor and according to package labeling. However, liver damage -- including severe liver damage -- can occur with Tylenol under certain circumstances. Taking too much Tylenol can damage the liver. Adults should not take more than 1 gram (1000 mg) of Tylenol in one dose or 4 grams (4000 mg) in one day. The maximum recommended dose of Tylenol in children is much lower. Liver damage can also occur in people taking Tylenol if they also take other drugs containing acetaminophen or if they drink 3 or more alcoholic beverages every day. People with liver disease should consult with their healthcare provider before taking Tylenol. Tylenol can worsen high blood pressure and kidney problems. Tylenol may also increase the blood thinning effects of Coumadin (warfarin). People who are allergic to Tylenol, acetaminophen, or any inactive ingredients in the product should not take Tylenol. Derek Dore, PharmD

Q: How long can I take Tylenol for before it becomes dangerous? I have been using it for shoulder pain for 6 months. I take 2 in the morning and 2 before bedtime.

A: Tylenol (acetaminophen) is an over-the-counter pain reliever. Tylenol inhibits substances called prostaglandins which reduces fever and pain. Tylenol is indicated for moderate pain. However, Tylenol does not work on inflammation. Tylenol can be taken with or without food. Common side effects associated with Tylenol include stomach upset, nausea, and loss of appetite. Current recommendations advise that it is important not to take more than the maximum dosage of 4000 mg per day or 1000 mg per single dose. However, McNeil, the manufacturer of brand-name Tylenol, has recently announced they are lowering the maximum daily dose of their product to 3000 mg per day. This change will be reflected in the new packaging for brand-name Tylenol beginning in Fall 2011. Doses exceeding this amount could cause potential adverse effects on the liver. Chronic alcoholics should inform the doctor if they exceed more than 3 drinks per day, especially if 2 g of Tylenol are taken in a day. According to prescribing information, there are no guidelines regarding how long Tylenol can be taken. It is important to never exceed the recommended amount and consult with the doctor if the pain is not adequately controlled. Always inform your doctor about all over-the-counter products you may take including vitamins, herbals and supplements. Some over-the-counter products may interact with other medications. Also, tell your pharmacist about all the prescription medication and over-the-counter products you take so the pharmacist can accurately check the medications for drug interactions. For more information on Tylenol, or other medications, consult with your doctor or pharmacist. Kimberly Hotz, PharmD

Q: Can I take Tylenol without food?

A: Tylenol (acetaminophen) is a medication commonly used to relieve mild to moderate pain from a variety of health conditions including headaches, muscle aches, menstrual periods, colds and sore throats, toothaches, and to reduce fever. Acetaminophen may also be used to relieve the pain of osteoarthritis (arthritis caused by the breakdown of the lining of the joints). Acetaminophen is categorized in a class of medications called analgesics (pain relievers) and antipyretics (fever reducers) and works by changing the way the body senses pain and by cooling the body. Acetaminophen comes in many different oral formulations. It is available as a tablet, chewable tablet, capsule, suspension or solution (liquid), drops (concentrated liquid), powder, extended-release (long-acting) tablet, and orally disintegrating tablet (tablet that dissolves quickly in the mouth). According to the manufacturer's drug information, the way acetaminophen acts on the body is not affected by eating, so it may be taken with or without food. For more specific information, consult with your doctor or pharmacist for guidance based on your health status and current medications, particularly before taking any action. Crystal Riley, PharmD

Q: If a person can take Regular Strength Tylenol, is it safe to take Tylenol Arthritis?

A: Tylenol Arthritis is an extended release form of Tylenol. The warnings for Tylenol Arthritis are very similar to Regular Strength Tylenol. However, the dose of Tylenol Arthritis is not the same as Regular Strength Tylenol. Tylenol Arthritis is also for adults 18 years of age or older. Tylenol Arthritis comes in geltabs, gelcaps, or tablets. Each tablet contains 650 mg of acetaminophen versus 325 mg in each regular strength tablet. The tablet is formulated in two layers. One layer releases medication quickly, and the other layer releases the medication over time to provide up to eight hours of relief. The directions for Tylenol Arthritis are two tablets (swallow only one at a time) every eight hours, not to exceed six tablets in a 24 hour period. Wash each tablet down with up to eight ounces of water. Tylenol Arthritis should not be chewed, crushed, or split. One of the additional warnings associated with Tylenol Arthritis is that the tablets (or geltabs or gelcaps) may get caught in the throat. If this happens, stop taking the medication and contact your doctor. Please consult with your health care provider to see if Tylenol Arthritis is appropriate for you. For more specific information, consult with your doctor or pharmacist for guidance based on your health status and current medications, particularly before taking any action. Kristen Dore, PharmD

About Drugs A-Z

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